Healthcare Provider Details

I. General information

NPI: 1144273673
Provider Name (Legal Business Name): SUSHEELA RAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HOSPITAL DR SUITE 300
BATAVIA OH
45103-1978
US

IV. Provider business mailing address

2055 HOSPITAL DR SUITE 300
BATAVIA OH
45103-1978
US

V. Phone/Fax

Practice location:
  • Phone: 513-732-0663
  • Fax: 513-732-1232
Mailing address:
  • Phone: 513-732-0663
  • Fax: 513-732-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-077077
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35-077077
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: